RESUMO
Inherited thrombophilias are associated with an increased risk of maternal thromboembolism and certain adverse pregnancy outcomes, including second- and third-trimester fetal loss, placental abruption, severe intrauterine growth restriction, and early-onset, severe preeclampsia. Pregnant patients with severe thrombophilias, especially antithrombinopathies are at very high risk for both thromboembolism and adverse pregnancy outcomes. A case of a patient with antithrombin deficiency is reported, who had two successful pregnancies after eight miscarriages. Our case shows that a combined treatment with antithrombin substitution and a prophylactic, body-weight-adjusted dose of low-molecular-weight heparin may be successful in preventing pregnancy loss and thromboembolism in antithrombin deficiency during pregnancy, although other complications, such as preeclampsia and intrauterine growth restriction cannot always be prevented.
Assuntos
Aborto Habitual/prevenção & controle , Anticoagulantes/uso terapêutico , Fibrina/deficiência , Heparina/uso terapêutico , Complicações Hematológicas na Gravidez/genética , Adulto , Feminino , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/terapia , Gravidez , Tromboembolia/genética , Trombofilia/genética , Resultado do TratamentoAssuntos
Doenças Fetais/prevenção & controle , Ruptura Prematura de Membranas Fetais/tratamento farmacológico , Pulmão/anormalidades , Cloreto de Sódio/administração & dosagem , Âmnio , Anormalidades Congênitas/prevenção & controle , Feminino , Humanos , Injeções , Gravidez , Cloreto de Sódio/uso terapêuticoRESUMO
Our objective was to present a comprehensive description of the clinicopathological findings of 173 abortions, including 121 therapeutic and 52 spontaneous ones in the period between 1992 and 1998. In all of these fetuses pathological examination was carried out. It was complemented when indicated by immunohistochemistry, in situ hybridization, flow cytometry, and X-ray examination. In the 121 therapeutic abortions the distribution of malformations was: 45 central nervous system anomalies (37%), 12 genitourinary anomalies (10%), 25 gastrointestinal anomalies (21%), two respiratory system anomalies (1.65%), eight cardiac anomalies (6.6%) and 28 other anomalies (17.2%) as revealed by autopsy. From the clinically selected 52 spontaneous abortions, major malformations were seen in 15/52 cases. With the comparison of the pathological and clinical findings in 121 therapeutic abortions, the percentage of cases with correct clinical designation and no missed anomalies amounted for 49%. However in 51% additional or different lethal, severe, or major malformations were revealed or excluded by fetopathological examinations. In 4% the clinical observation and diagnosis were modified, but without implications for the therapeutic termination of pregnancy. The clinical indication could not be supported in another 3% of the cases.
Assuntos
Autopsia , Aberrações Cromossômicas/patologia , Feto/patologia , Aborto Espontâneo/patologia , Aborto Terapêutico , Sistema Nervoso Central/anormalidades , Transtornos Cromossômicos , Anormalidades do Sistema Digestório , Feminino , Doenças Fetais/patologia , Idade Gestacional , Cardiopatias Congênitas/patologia , Humanos , Hibridização in Situ Fluorescente , Pulmão/anormalidades , Gravidez , Anormalidades Urogenitais/patologiaRESUMO
In a retrospective study from 210 foetal autopsies carried out in a period between 1992 and 1999 fifteen hydropic foetuses were found. The cause of the hydrops was shown to be Rh incompatibility in one case only. The cause of hydrops was not discernible in one case. In the others pathological examination clarified the cause and pathomechanism of non-immune hydrops. One isolated cystic hygroma, one monochorionic twin pregnancy with twin to twin transfusion, one case of sacrococcygeal teratoma and 4 cases of congenital heart diseases were reported. Postmortem interphase cytogenetic examination showed X0 monosomy in 2 cases. In further 4 foetuses pathognomic viral inclusions in the proerythroblasts raised the probability of parvovirus B19 infection what was confirmed by immunohistochemistry and electronmicroscopic examination. The occurrence of the parvovirus B19 associated cases of foetal hydrops was shown to be higher (4/15) in this series than in the literature. The accumulation of cases in 1998 is suggestive of an outbreak. The prenatal diagnostic implications and the attempts on further management are also discussed.
Assuntos
Hidropisia Fetal/complicações , Infecções por Parvoviridae/complicações , Parvovirus B19 Humano , Adulto , Autopsia , Feminino , Idade Gestacional , Humanos , Imuno-Histoquímica , Hibridização In Situ , Microscopia Eletrônica , Infecções por Parvoviridae/virologia , Parvovirus B19 Humano/isolamento & purificação , Gravidez , Estudos RetrospectivosRESUMO
To test the effects of calcium dobesilate (Doxium) in pregnancies complicated with pregnancy-induced hypertension or mild/moderate pre-eclampsia a double-blind, placebo-controlled pilot study was carried out. Primigravida patients (gestational age =34 weeks) daily took 2 g Doxium or placebo until delivery. Twelve patients received placebo for 53 days, and 11 patients took the drug for 57 days on average. At the start of the study 2 patients in the placebo group (PG) and 8 in the Doxium group (DG) had pre-eclampsia. The mean arterial pressure (mean +/- SD) significantly decreased from 118 +/- 7 to 99 +/- 9 mm Hg in the DG (p = 0.003), while in the PG it had slightly increased by the end of the study. Proteinuria was higher in the DG at the start but not at the end; however, significant changes of this parameter were detected in neither of the groups throughout the study. Fibronectin decreased significantly in both groups but it was more pronounced in the DG (23.8 vs. 9.4%). Changes of platelet count, plasma and blood viscosity, and erythrocyte deformability were favourable in the DG but in the PG these parameters had deteriorated although the alterations were not significant. No marked differences were found between the two groups regarding fetal well-being, courses of deliveries, and the neonatal period. Neither maternal nor fetal/neonatal side effects were noticed. It seems that Doxium favourably influences the blood pressure and consequently decreases the requirement for medication and hospitalisation in cases of mild to moderate midtrimester hypertension.
Assuntos
Dobesilato de Cálcio/uso terapêutico , Hemostáticos/uso terapêutico , Hipertensão/tratamento farmacológico , Complicações Cardiovasculares na Gravidez/tratamento farmacológico , Viscosidade Sanguínea , Dobesilato de Cálcio/efeitos adversos , Método Duplo-Cego , Deformação Eritrocítica , Feminino , Fibronectinas/sangue , Humanos , Hipertensão/sangue , Projetos Piloto , Placebos , Contagem de Plaquetas , Pré-Eclâmpsia/tratamento farmacológico , Gravidez , Complicações Cardiovasculares na Gravidez/sangue , Resultado da Gravidez , Segundo Trimestre da Gravidez , ProteinúriaRESUMO
Maternal leptin levels in serum and urine, their relations to maternal weight and body mass index, were examined in 9 healthy pregnant women from the 12th week of gestation until term. Serum leptin concentration was found to increase progressively during the first two trimesters followed by a slight decline thereafter. The peak value of 27.6 +/- 15.3 ng/ml (mean +/- SD) concentration was reached at the 28th week. Serum leptin levels during the first two trimesters correlated significantly with maternal weight (p = 0.002) and body mass index (p = 0.002) but such a relationship was absent during the third trimester. Leptin could be detected only in about half of urine samples; its concentrations proved to be independent of serum values. No correlation was found between maternal serum leptin levels and the birth weight of neonates. Maternal leptin levels appear to refer to alterations in maternal fat tissue mass that occur during pregnancy.
Assuntos
Proteínas/metabolismo , Índice de Massa Corporal , Peso Corporal , Feminino , Idade Gestacional , Humanos , Leptina , Gravidez , Valores de ReferênciaRESUMO
The effect of visceral peritoneal closure after conventional abdominal hysterectomies and Wertheim-Meigs radical operations was studied clinically. No considerable differences were found in the postoperative staying period; however, the incidence of complications were less in the peritoneal non-closure group (n = 91) than in the control, peritonealized group (n = 149). Significantly lower was the number of postoperative irregular pyelogram in cases without peritoneal closure (n = 25) of radical abdominal operations than in the control group (n = 49) with peritoneal suturing. We therefore suggest that the lack of suturing of visceral peritoneums has some advantages after abdominal hysterectomies and especially has benefits for Wertheim-Meigs operations.